Surgical clamp

ABSTRACT

A novel surgical clamp having a pair of jaws, which may be used to ablate or create leisons in tissue. In embodiment, the jaws have an articulated position wherein the jaws are separated and not parallel to one another, an opened position wherein the jaws are separated and substantially parallel to one another, and a closed position wherein the jaws are adjacent and substantially parallel to one another. One or more of the jaws can articulate independent of the other jaw. Other embodiments are described in the attached specification.

RELATED APPLICATIONS

This application claims the benefit of U.S. provisional application No.60/620,609 filed on Oct. 20, 2004.

BACKGROUND

The present invention relates to surgical instruments, with someembodiments relating clamps, articulated clamps, and tissue ablatingclamps. Surgery generally refers to the diagnosis or treatment ofinjury, deformity, or disease. In a variety of surgical procedures, itis desired to ablated tissue or cause lesions in tissue. Some examplesof such procedures include, without limitation, electrical isolation ofthe pulmonary veins to treat atrial fibrillation, ablation of uterinetissue associated with endometriosis, ablation of esophageal tissueassociated with Barrett's esophagus, ablation of cancerous liver tissue,and the like. The foregoing examples are merely illustrative and notexhaustive. While a variety of techniques and devices have been used toablate or cause lesions in tissue, no one has previously made or used anablation device in accordance with the present invention. Other aspectsof the present teaching relate to novel clamping devices and are notlimited to tissue ablation.

BRIEF DESCRIPTION OF DRAWINGS

While the specification concludes with claims which particularly pointout and distinctly claim the invention, it is believed the presentinvention will be better understood from the following description ofcertain examples taken in conjunction with the accompanying drawings, inwhich like reference numerals identify the same elements and in which:

FIG. 1 illustrates an oblique view of an example of an articulated clampin an articulated position;

FIG. 2 illustrates an oblique view of the articulated clamp of FIG. 1 inan opened position;

FIG. 3 illustrates an oblique view of an example of an articulated clampin an opened position;

FIG. 4 illustrates an oblique view of the articulated clamp of FIG. 3 inan opened position;

FIG. 5 illustrates an oblique view of an example of an articulated clampin an articulated position;

FIG. 6 illustrates an oblique view of the articulated clamp of FIG. 5 inan articulated position;

FIG. 7 illustrates an oblique view of the articulated clamp of FIG. 5 inan opened position;

FIG. 8 illustrates a plan view of an example of a clamp with multipledegrees of freedom;

FIG. 9 illustrates an oblique view of an example of an articulatedclamp;

FIG. 10 illustrates a cross-sectional view of the actuator of thearticulated clamp of FIG. 9;

FIG. 11 illustrates a cross-sectional view of the actuator of thearticulated clamp of FIG. 9;

FIG. 12 illustrates an oblique view of the distal end of the articulatedclamp of FIG. 9;

FIG. 13 illustrates a side view of an example of linkages to effectarticulation of a clamp;

FIG. 14 illustrates a side view of an example of linkages to effectarticulation of a clamp;

FIG. 15 illustrates a side view of an example of linkages to effectarticulation of a clamp; and

FIG. 16 illustrates a side view of an example of linkages to effectarticulation of a clamp.

DETAILED DESCRIPTION

The following description of certain examples of the invention shouldnot be used to limit the scope of the present invention. Other examples,features, aspects, embodiments, and advantages of the invention willbecome apparent to those skilled in the art from the followingdescription, which is by way of illustration, one of the best modescontemplated for carrying out the invention. As will be realized, theinvention is capable of other different and obvious aspects, all withoutdeparting from the invention. Accordingly, the drawings and descriptionsshould be regarded as illustrative in nature and not restrictive.

In a variety of surgical procedures, it is desirable to ablated tissueor cause lesions in tissue. Tissue ablation can be effected through avariety of different mechanisms known to those skill in the art, such asmono-polar radiofrequency (“RF”) energy, bi-polar RF energy, cryogenictechniques, and the like. In clamping arrangements, tissue ablation canbe effected through a single jaw of a clamp or through both jaws of aclamp. Tissue ablation will typically be performed once the targettissue is clamped between the closed jaws. One with ordinary skill inthe art will recognize that one or more of the foregoing tissue ablationtechniques may be employed with the various clamp configurationsdescribed below. One with ordinary skill in the art will also recognizeadvantages of the surgical clamps without tissue ablation functionality.Accordingly, the foregoing examples may or may not include ablationfunctionality.

FIG. 1 illustrates an example of an articulated clamp (100). The clamp(100) includes a shaft (110), a distal jaw (120), and proximal jaw(130). The shaft could be straight, curved, rigid, flexible, malleable,or articulated. In this embodiment, the jaws are substantially straight;however, the jaws could also be curved in one or more directions. Asshown here, the jaws are in an articulated position where the jaws areseparated and not parallel to one another. The distal jaw (120) canarticulate relative the shaft (110) independent of the proximal jaw(130). As shown here, the distal jaw (120) extends distally relative theshaft (110) and the proximal jaw (130) extends laterally relative theshaft (110). Note that the distal jaw (120) need not be axially alignedthe with shaft (110), and likewise the proximal jaw (130) need notextend normal the shaft (110). Instead, angular variations arecontemplated, and in many cases may be advantageous based on the anatomyor surgical procedure.

FIG. 2 illustrates the articulate clamp (100) in an opened positionwhere the jaws are separated and substantially parallel to one another.The distal jaw (120) has been articulated such that the distal jaw (120)extends laterally from the shaft (110). The articulation can be passive.For instance, the articulated jaw can be “limp” and readily moveable inresponse to external forces, such as when pressed against tissue, orresisted by a spring, damper, friction, or other biasing mechanism.Alternatively, the articulation could be active in which thearticulation is remotely activated through an actuator (not shown), suchas one located on the proximal end of the shaft (110). With activearticulation, the jaw is generally rigid and immobile in response toexternal forces. The jaws can move to a closed position wherein the jawsare adjacent and substantially parallel to one another. As shown in thisexample, one or both of the jaws will move axially relative to the shaft(110) such that the jaws remain parallel to one another between theopened and closed positions.

FIG. 3 illustrates another example of an articulated clamp (200). Theclamp (200) includes a shaft (210), a distal jaw (220), and proximal jaw(230). The shaft could be straight, curved, rigid, flexible, malleable,or articulated. In this embodiment, the jaws are substantially straight;however, the jaws could also be curved in one or more directions.Similar to scissors-type motion, the jaw are pivotally moveable relativeone another between an opened position and a closed position. As shownhere, the jaws are in an opened position where the jaws are separatedand not parallel to one another. In the closed position the jaws arepivoted so they are adjacent and parallel to one another. The distal jaw(220), proximal jaw (230), or both may pivot to effect the opening andclosing.

As shown in FIG. 4, the jaws have been articulated relative the shaft(210). In this embodiment, the jaws can be articulated relative theshaft (210) independent of the jaw pivotal motion. Thus, the jaws remainin the opened position but can be articulated. Likewise, the jaws couldarticulate while the jaws are partially or completely closed. The jawarticulation could extend through a broad range of angles. As shownhere, the articulation angle is between 0 and 45 degrees relative theshaft (210); however the articulation range could be much wider. Forinstance, the jaws could articulate from −90 to +90 degrees relative theshaft (210). The same or different actuator mechanism (not shown) caneffect the jaw pivoting and jaw articulation.

FIG. 5 illustrates another example of an articulated clamp (300). Theclamp (300) includes a shaft (310), a distal jaw (320), and proximal jaw(330). The shaft could be straight, curved, rigid, flexible, malleable,or articulated. In this embodiment, the jaws are curved; however, thejaws could also be straight or curved in other configurations. As shownhere, the jaws are in an articulated position where the jaws areseparated and not parallel to one another. As shown here, the distal jaw(320) is extends distally relative the shaft (310) and the proximal jaw(330) extends proximally relative the shaft (310). In the presentembodiment, the jaws each have a electrodes (322, 332) to effect tissueablation through bi-polar or mono-polar RF energy.

In this embodiment, the distal jaw (320) and proximal jaw (330)articulate relative the shaft (310), either in cooperation with orindependent of one another. For instance, FIG. 6 illustrates anotherarticulated position where the jaws are separated and not parallel toone another. The distal jaw (320) has been articulated such that itextends laterally relative the shaft (310), while the proximal jaw (330)has remained unmoved. FIG. 7 illustrates the articulate clamp (300) inan opened position where the jaws are separated and substantiallyparallel to one another. This view also illustrates recesses (312, 314)in the shaft (310) to receive the proximal jaw (330) when articulated inthe fully proximal direction. The proximal jaw (330) has beenarticulated such that it extends laterally from the shaft (310). Thejaws can then move to a closed position wherein the jaws are adjacentand substantially parallel to one another. As shown in this example, oneor both of the jaws will move axially relative to the shaft (310) suchthat the jaws remain parallel to one another between the opened andclosed positions.

Note that the distal jaw (320) and/or proximal jaw (330) need not beaxially aligned the with shaft (310) in the articulated positions.Likewise, the distal jaw (320) and proximal jaw (330) need not extendnormal to the shaft (310) in the opened or closed positions. Instead,angular variations are contemplated, and in many cases may beadvantageous based on the anatomy or surgical procedure.

One advantage of articulated clamps (such as embodiments 100, 200, and300) is the ability to position the jaws near target tissue. Thisability is often desirable when operating on or near complicated orsensitive anatomy, or in minimally invasive surgical procedures. As anon-limiting example, the articulated clamp (300) is well suited foropen or minimally invasive surgery to treat atrial fibrillation byelectrically isolating the left or right pair of pulmonary veinsadjacent the left atrium. The articulated jaw positions facilitatepositioning the device near the target tissue. The distal and/orproximal jaws may then be articulated to the opened position such thatthe tissue being treated is interposed between the jaws. The jaws maythen be closed and the tissue ablated.

FIG. 8 illustrates an example of a scissor-type clamp (400) withmultiple degrees of freedom. The clamp includes two clamp member (412,413) in crossed relation to each other. Each clamp member has a distalend with a jaw (420, 430) and a proximal end with a handle (414, 415).In this embodiment, the jaws are substantially straight; however, thejaws could also be curved in one or more directions. Preferably, theclamping surfaces of the jaws (420, 430) have tissue ablationfunctionality, such as mono-polar or bi-polar electrodes. A joint (422)connects the two clamp members (412, 413) where they cross. The jointmates with a lateral slot (432). A biasing mechanism, which in this caseis a U-shaped spring (434), biases the jaws (420, 430) towards oneanother along the lateral slot (432). Thus, this embodiment has twodegrees of freedom. The first degree of freedom allows the relativerotation of the two clamp members about the joint. The second degree offreedom allows transverse movement between the two clamp members.

One advantage of this embodiment (400) is the ability to clamp tissuewhile maintaining a consistant clamping force along the lengths of thejaws. This is especially useful when clamping thicker tissue. Thetransverse degree of freedom prevents a disproportionate clamping forcetoward the pivot point of the joint (422). In addition, the spring (434)provides a maximum clamping force, which may be useful in certainprocedures or to avoid traumatizing sensitive tissues.

FIG. 9 illustrates another example of an articulated clamp (500). Thisembodiment can be used to create lesions on the heart to treat atrialfibrillation. The clamp (500) includes a shaft (510), a distal jaw(520), a proximal jaw (530), and an handle (600). As shown here, theshaft (510) is straight and rigid; however, it could also be curved,flexible, malleable, or articulated. In the present embodiment, the jawseach have slender electrodes (not shown) on the clamping surfaces toeffect tissue ablation through bi-polar or mono-polar RF energy. Thejaws are curved; however, the jaws could also be straight or curved inother configurations. As shown here, the jaws are in an opened positionwhere the jaws are separated and parallel to one another. The jaws bothextend laterally relative the shaft (510), but not necessarily normalthe shaft. The distal jaw (520) can articulate relative the shaft (510)independent of the proximal jaw (530). In this example, the distal jaw(520) can articulate diotally up to about axial alignment with the shaft(510); however, wider or narrower ranges are also contemplated. In thisexample, the proximal jaw (530) cannot articulate relative the shaft(510). The proximal jaw (530) can move axially along the shaft (510) toa closed position where the jaws are adjacent and substantially parallelto one another. Preferably, the distal jaw (520) will lock in thisposition parallel to the proximal jaw (530) when the jaws are in theclosed position or while the proximal jaw (530) is being moved towardthe closed position.

In one variation, the distal jaw (520) is “limp” when articulating.Accordingly, the distal jaw will articulate passively in response tominimal external forces. Optionally, the tip of the distal jaw (520)includes a fastener (522), shown here are a female member, dimensionedto a male fastener counterpart of an instrument guide. For instance, theinstrument guide can be an elongate flexible member. When the instrumentguide is anchored to the fastener (522), the distal jaw (520) may bepositioned to a desired location in the surgical field by pulling theinstrument guide. Preferably, the distal jaw (520) will be in itsarticulated “limp” position so as to reduce interference by surroundinganatomy. The distal and proximal jaws may then be adjusted so that thetissue being treated is interposed between the jaws. The jaws may thenbe closed and the tissue ablated. After treatment is concluded, and theclamp is opened, the distal jaw will be in its articulated “limp”position, thus pulling the instrument guide until the instrument guideis removed from the surgical field. Examples of instrument guides andexemplary surgical procedures are disclosed in U.S. patent applicationSer. No. 11/254,057 filed on even date herewith, the teachings of whichare incorporated by reference.

FIGS. 10 and 11 illustrates some features of the handle (600). Thehandle includes grips (601, 602, 603). A port (605) is provided throughwhich wires or tubes may extend from the interior to the exterior of thehandle. For instance, wires for the ablation electrodes or sensors onthe jaws can be threaded through the shaft (510) into the handle (600)and out through the port (605).

The handle (600) also houses an actuator mechanism. In this example aplunger (610) is used to actuate the jaws. Here, the plunger (610) isaligned with the shaft (510). In the fully retraced or proximal position(as shown), the distal jaw is in its articulated “limp” position. Whenthe plunger (610) is depressed in the distal direction, the distal jaw(520) locks into a position parallel with the proximal jaw (530).Further depression will move the proximal jaw (530) distally towards theclosed position. The plunger (610) includes a slot (611) with an opening(612). When the jaws are in the closed position, the opening (612)aligns with the lock (620). A spring (634) forces the lock (620) intothe opening (612) preventing the plunger (610) from moving proximally,thus maintaining the jaws in the closed position. Depressing the lock(620) will release the plunger (610) thus allowing proximal movement.

An actuator rod (650) actuates the jaws. Distal movement closes the jawswhile proximal movement opens the jaws. The plunger (610) includes arelief rod (613) surrounded in a force limiting spring (633). The forcelimiting spring (633) is compressed between the step (614) and theactuator rod (650). Depressing the plunger (610) imparts a load on theforce limiting spring (633) that is translated to the actuator rod(650), which will move the actuator rod (650) distally. A return spring(632) is operative to move the actuator rod (650) proximally uponreleasing the plunger (610). If the jaw clamping load exceeds load ofthe force limiting spring (633), the slot and pin (615, 631) interfaceallows the relief rod (613) to move distally without moving the actuatorrod (650). Thus, the force limiting spring (633) effectively defines themaximum jaw clamping load. One with ordinary skill in the art willrecognize that the tissue clamping pressure if a function of the jawclamping load and the tissue area being clamped.

While not required, the jaws will preferably move between the opened andclosed positions in a 1:1 ratio relative the motion of the plunger(610). Likewise, the jaw clamping load preferably will have a 1:1 ratiorelative the depression load on the plunger (610). One advantage of the1:1 relative ratios of movement and/or load is to improve tactilefeedback from the jaws to the surgeon during a surgical procedure.

FIG. 12 shows an rear view of the distal end of the clamp (500) in theopened position. The shaft (510) includes a weep hole (512) to helpdrain fluids.

FIGS. 13-16 illustrate an example (700) of means to articulate, open,and close the jaws of a clamp, such as the clamp (500). These figuresshow a shaft (710), a distal jaw (720), and a proximal jaw (730). Anactuator rod (750) is positioned in the shaft (710) and is attached tothe proximal jaw (730). Axial movement of the actuator rod (750) istranslated to axial movement of the proximal jaw (730). The proximal jaw(730) extends laterally relative the shaft (510) at a constant angle.Connected to the proximal jaw (730) is a guide pin (732) seated in thelongitudinal slot (712) in the shaft (710). The guide pin/slot interfaceprevents the proximal jaw (730) from rotating about the axis of theshaft (710) regardless of the axial position of the proximal jaw (730).

The distal jaw (720) articulates relative the shaft (710) about the pin(722). A locking rod (740) is connected to the distal jaw (720) with thepin (742). A follower pin (744) is attached to the locking rod (740) andis seated in the L-shaped locking slot (714) in the shaft (710) and thestepped follower slot (752) in the actuator rod (750).

FIGS. 13 and 14 illustrate the passive articulation of the distal jaw(720) while the actuator rod (750) in its proximal-most position. FIG.13 shows the distal jaw (720) in its fully articulated position and FIG.14 shows the distal jaw (720) in its opened position where the jaws areseparated and parallel to one another. As the distal jaw (720)articulates, the follower pin (744) moves axially within the limits ofthe axial leg of the locking slot (714).

In FIG. 15 the actuator rod (750) has been moved distally. If the distaljaw (720) is in an articulated position, the step in the follower slot(752) will push the follower pin (744) distally thus articulating thedistal jaw (720) to the opened position. The angled step in the followerslot (752) will also push the follow pin (744) upward in the lockedportion (715) of the slot (714), as shown in this figure. In thisposition, axial movement of the follower pin (744) is restricted, thuslocking the distal jaw (720) in a position parallel to the proximal jaw(730).

FIG. 16 illustrates the actuator rod (750) being moved further in thedistal direction. The proximal jaw (730) advances towards the closedposition. The follower pin (744) remains in the locked position withinthe locking portion (715). The follower pin (744) is also in the upperstep of the follower slot (752) so axial movement of the actuator rod(750) is unrestricted.

Having shown and described various embodiments of the present invention,further adaptations of the methods and systems described herein may beaccomplished by appropriate modifications by one of ordinary skill inthe art without departing from the scope of the present invention.Several of such potential modifications have been mentioned, and otherswill be apparent to those skilled in the art. For instance, theexamples, embodiments, geometries, materials, dimensions, ratios, steps,and the like discussed above are illustrative and are not required.Accordingly, the scope of the present invention should be considered interms of the following claims and is understood not to be limited to thedetails of structure and operation shown and described in thespecification and drawings.

1. A surgical clamp comprising: a) a shaft having a proximal end and adistal end; b) a first jaw and a second jaw connected to the shaft foreffecting a surgical procedure, the second jaw being pivotably connectedto the shaft; c) a locking member operably connected to the second jawoperable to lock the second law against pivoting motion with respect tothe first jaw; wherein the jaws have respective first and secondclamping surfaces and the jaws are operable to assume: (i) anarticulated position wherein the jaws clamping surfaces are separatedand not substantially parallel to one another; (ii) an opened positionwherein the jaws clamping surfaces are separated and the second jaw islocked against pivoting motion with respect to the first jaw, with theclamping surfaces substantially parallel to one another; and (iii) aclosed position wherein the jaws clamping surfaces are adjacent and thesecond jaw is locked against pivoting motion with respect to the firstjaw, with the clamping surfaces substantially parallel to one another;the jaws being movable between the opened and closed positions when thesecond iaw is locked against pivoting motion with respect to the firstjaw.
 2. The surgical device clamp of claim 1, further comprising anactuator attached to the proximal end of the shaft operable to move thejaws between the closed, opened, and articulated positions.
 3. Thesurgical device clamp of claim 1, wherein the jaws effect tissueablation.
 4. The surgical device clamp of claim 3, further comprisingelectrodes on the jaws.
 5. The surgical device clamp of claim 4, whereintissue ablation is effected by bi-polar energy.
 6. The surgical deviceclamp of claim 1, wherein in the closed position the clamping surfacesextends laterally from the shaft.
 7. The surgical device clamp of claim1, wherein in the articulated position the second jaw extends distallyrelative to the shaft.
 8. The surgical device clamp of claim 1, furthercomprising means to articulate, open, and close the jaws.
 9. Thesurgical device clamp of claim 1, wherein at least one of the jaws iscurved.
 10. The surgical device clamp of claim 1, wherein at least oneof the jaws moves toward the closed position by moving axially along theshaft.
 11. The surgical device clamp of claim 1, wherein the second jawarticulates relative to the shaft independent of the proximal first jaw.12. The surgical device clamp of claim 11, wherein the first jawarticulates relative to the shaft independent of the second jaw.
 13. Asurgical clamp comprising: a) a shaft; b) a first jaw connected to theshaft; c) a second jaw pivotably connected to the shaft, and d) alocking member operably connected to the second jaw operable to lock thesecond jaw against pivoting motion with respect to the first jaw;wherein at least one of the first jaw or the second jaw is movabletoward and away from the other jaw when the second jaw is locked againstpivoting motion.